Testing Concerns & Security Violations Report

Testing Concerns & Security Violations Report

This form is designed to allow individuals who have concerns regarding the administration of Indiana assessments to notify the Indiana Department of Education (IDOE) of potential integrity and security concerns. All concerns supported by “articulable facts” will be further investigated. The corporation/school against which the concern is raised will be notified (and provided a copy of this report), and IDOE will review appropriate test administration procedures with the corporation/school, as needed.

Note: This form is not designed for use by corporations or schools to report a testing Irregularity. The Testing Irregularity Report form link in Appendix C of the Indiana Assessments Policy Manual should be used to report irregularities that are not related to test security concerns.
Select the testing window in which the concern/violation occurred.*

ILEARN 3-8IREADILEARN CheckpointsILEARN Biology ECAWIDA ACCESSI AMILEARN U.S. Government ECA
Date of Incident*

MonthDayYear
Date
Corporation Name:*
Corporation Number:
School Name:*
School Number:
Person Submitting Form:*

First NameLast Name
Title:*
Phone Number*
Email*

Confirmation Emailexample@example.com
Corporation Test Coordinator:

First NameLast Name
Corporation Test Coordinator Phone Number:
Corporation Test Coordinator Email:*

Confirmation Emailexample@example.com
Please provide a detailed description of the test security concern or violation. Please do not include any personally-identifiable student information:*
How did you learn of the test security concern or violation?*
STNs:
Optional: Upload STN File

Cancelof
Session ID (if applicable):
Test Name (e.g., IREAD-3 Segment 1):*
Have any tests been invalidated?*

YesNoUnknown
Number of tests invalidated:
Identify witnesses, names, and phone numbers, as applicable.
If you were involved directly as a parent, school employee, or student, please explain your involvement:
Please include any other evidence/supporting documentation regarding this concern:

Cancelof
Although IDOE does not have jurisdiction over all concerns, our agency is always willing to work with local corporations and schools to clarify appropriate procedures for testing. The concern can frequently be corrected by providing corporations/schools with additional information about correct test administration procedures. Thank you for sharing your concern.
Signature:*

Clear
Should be Empty: